Shamanewadi Amrita N, Naik Poonam R, Thekkur Pruthu, Madhukumar Suwarna, Nirgude Abhay Subhashrao, Pavithra M B, Poojar Basavaraj, Sharma Vivek, Urs Arnav Prashanth, Nisarga B V, Shakila N, Nagaraja Sharath Burugina
Department of Community Medicine, MVJ Medical College and Research Hospital (MVJMCRH), Dandupalya, Hoskote, Bengaluru Rural Pin-562114, India.
Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore Pin-575018, India.
Tuberc Res Treat. 2020 Jan 24;2020:9746329. doi: 10.1155/2020/9746329. eCollection 2020.
Active case finding (ACF) for tuberculosis (TB) is a promising tool to enhance early case detection among marginalized populations. As opposed to passive case finding, it involves systematically searching for TB in individuals who would not spontaneously present for care. The National TB Program (NTP) of India has initiated ACF for TB through the existing general health system since the end of 2017. However, prior to scale-up, there is need for exploring the implementation challenges and solutions to improve the efficiency of this program.
(1) To explore the enablers and challenges in the implementation of ACF for TB by NTP in the Bengaluru rural district of Karnataka, South India, and (2) to explore the perceived solutions to improve the efficiency of ACF activity.
A qualitative descriptive study was conducted in the Bengaluru rural district during July 2018. In-depth interviews using purposively selected health care providers involved in active case finding ( = 9) and presumptive TB patients ( = 9) and presumptive TB patients (.
The challenges in conduct of ACF were as follows: inadequate training of health care workers, shortage of staff, indifferent attitude of community due to stigma, lack of awareness about TB, illiteracy, inability to convince patients for sputum test, and delay in getting CBNAAT results. The field staff recommended the installation of mobile CBNAAT machine, involvement of general health staff in activity, training of health workers on counseling of patients, and issue of identity cards for community health workers/volunteers so that people recognize them.
The health system challenges in conduct of ACF need to be addressed by training the health staff involved in activity and also improving the access to TB diagnostics.
结核病主动病例发现是一种很有前景的工具，有助于在边缘化人群中提高早期病例检出率。与被动病例发现不同，它需要系统地在那些不会主动前来就医的个体中查找结核病。自2017年底以来，印度国家结核病规划通过现有的综合卫生系统启动了结核病主动病例发现工作。然而，在扩大规模之前，需要探索实施过程中的挑战及解决方案，以提高该项目的效率。
（1）探讨印度南部卡纳塔克邦班加罗尔农村地区国家结核病规划实施结核病主动病例发现的促进因素和挑战；（2）探讨提高主动病例发现活动效率的可行解决方案。
2018年7月在班加罗尔农村地区开展了一项定性描述性研究。对参与主动病例发现的9名医护人员和9名疑似结核病患者进行了有目的选择的深入访谈。
主动病例发现实施过程中的挑战如下：医护人员培训不足、人员短缺、由于耻辱感社区态度冷漠、对结核病缺乏认识、文盲、无法说服患者进行痰检以及CBNAAT结果延迟获取。现场工作人员建议安装移动CBNAAT机器、让综合卫生工作人员参与活动、对医护人员进行患者咨询培训以及为社区卫生工作者/志愿者发放身份证以便人们识别他们。
开展主动病例发现时卫生系统面临的挑战需要通过培训参与活动的卫生工作人员以及改善结核病诊断服务的可及性来解决。
